| NPI | 1740471184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D07364) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 7364) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2021-11-24 |